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https://www.readbyqxmd.com/read/28338599/volumetric-control-of-whole-blood-collection-in-austere-environments
#1
Michael A Meledeo, Andrew D Fisher, Grantham C Peltier, Ethan A Miles, William B Muse, Win B Kerr, Shawn C Nessen, Andrew P Cap
INTRODUCTION: Fresh whole blood transfusions are a powerful tool in prehospital care; however, the lack of equipment such as a scale in field situations frequently leads to collections being under- or overfilled, leading to complications for both patient and donor. This study describes two methods for simple, rapid control of collection bag volume: (1) a length of material to constrict the bag, and (2) folding/clamping the bag. METHOD: Whole blood collection bags were allowed to fill with saline via gravity...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28318991/bleeding-control-using-hemostatic-dressings-lessons-learned
#2
REVIEW
Brad L Bennett
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#3
REVIEW
Russ S Kotwal, Frank K Butler
During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28315994/urgency-and-austerity-as-drivers-of-success
#4
Terry R Stouch
This piece describes the approach by which even a small CADD (Computer-Aided Drug Design) group with limited resources and limited time can achieve substantial success given short budgets and the compressed, urgent environment of a biotech. Some comparisons are made with CADD operations in big pharma.
March 18, 2017: Journal of Computer-aided Molecular Design
https://www.readbyqxmd.com/read/28291491/an-augmented-reality-based-approach-for-surgical-telementoring-in-austere-environments
#5
Dan Andersen, Voicu Popescu, Maria Eugenia Cabrera, Aditya Shanghavi, Brian Mullis, Sherri Marley, Gerardo Gomez, Juan P Wachs
Telementoring can improve treatment of combat trauma injuries by connecting remote experienced surgeons with local less-experienced surgeons in an austere environment. Current surgical telementoring systems force the local surgeon to regularly shift focus away from the operating field to receive expert guidance, which can lead to surgery delays or even errors. The System for Telementoring with Augmented Reality (STAR) integrates expert-created annotations directly into the local surgeon's field of view. The local surgeon views the operating field by looking at a tablet display suspended between the patient and the surgeon that captures video of the surgical field...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290927/understanding-primary-care-behavioral-health-across-military-settings-a-preliminary-comparison-between-deployed-and-in-garrison-care
#6
Ryan R Landoll, Matthew K Nielsen, Kathryn K Waggoner
BACKGROUND: Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285490/review-of-54-cases-of-prolonged-field-care
#7
Erik DeSoucy, Stacy Shackelford, Joseph J DuBose, Seth Zweben, Stephen C Rush, Russ S Kotwal, Harold R Montgomery, Sean Keenan
BACKGROUND: Prolonged field care (PFC) is field medical care applied beyond doctrinal planning time-lines. As current and future medical operations must include deliberate and contingency planning for such events, data are lacking to support efforts. A case review was conducted to define the epidemiology, environment, and operational factors that affect PFC outcomes. METHODS: A survey distributed to US military medical providers solicited details of PFC encounters lasting more than 4 hours and included patient demographics, environmental descriptors, provider training, modes of transportation, injuries, mechanism of injury, vital signs, treatments, equipment and resources used, duration of PFC, and morbidity and mortality status on delivery to the next level of care...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28285477/a-novel-ultrasound-transmission-gel-for-resource-constrained-environments
#8
Jonathan D Monti
Ultrasound represents an ideal diagnostic adjunct for medical personnel operating in austere environments, because of its increasing portability and expanding number of point-of-care applications. However, these machines cannot be used without a transmission medium that allows for propagation of ultrasound waves from transducer to patient. This article describes a novel ultrasound gel alternative that may be better suited for resource-constrained environments than standard ultrasound gel, without compromising image quality...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28285474/invasive-reduction-of-paraphimosis-in-an-adolescent-male-while-in-a-deployed-austere-environment
#9
Christopher Pham, Joseph Zehring, Cristobal S Berry-Caban
Paraphimosis is a urologic emergency resulting in tissue necrosis and partial amputation, if not reduced. Paraphimosis occurs when the foreskin of the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion, and cannot be returned to its normal position. Invasive reduction of paraphimosis requires minimal instruments and can be accomplished by experienced providers. This case describes a 10-year-old local national with paraphimosis over 10 days that required invasive reduction in a deployed austere environment in Africa...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28285473/a-modern-case-series-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-in-an-out-of-hospital-combat-casualty-care-setting
#10
Justin D Manley, Benjamin J Mitchell, Joseph J DuBose, Todd E Rasmussen
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to mitigate bleeding and sustain central aortic pressure in the setting of shock. The ER-REBOA™ catheter is a new REBOA technology, previously reported only in the setting of civilian trauma and injury care. The use of REBOA in an out-of-hospital setting has not been reported, to our knowledge. METHODS: We present a case series of wartime injured patients cared for by a US Air Force Special Operations Surgical Team at an austere location fewer than 3km (5-10 minutes' transport) from point of injury and 2 hours from the next highest environment of care-a Role 2 equivalent...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28284484/tactical-combat-casualty-care-transitioning-battlefield-lessons-learned-to-other-austere-environments
#11
EDITORIAL
Brad Bennett, Ian Wedmore, Frank Butler
No abstract text is available yet for this article.
March 8, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28263272/the-emotional-well-being-of-nurses-and-nurse-leaders-in-crisis
#12
Karen Livornese, Jena Vedder
In a world after 9/11, Hurricane Katrina, and Sandy Hook, plenty of literature has emerged on the subject of disaster management, but little is specific to the emotional well-being of the health care staff dedicated to serve during a crisis. Disasters, whether natural or man-made, are episodic but becoming more frequent. Nurses may find themselves in hospitals affected by a disaster, awaiting a surge of patients while supplied with only limited resources. Or, they may be deployed to austere environments where they are challenged to operate clinics, surrounded by the rubble of an earthquake...
April 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/28202309/working-in-scarcity-effects-on-social-interactions-and-biomedical-care-in-a-tanzanian-hospital
#13
Adrienne E Strong
Based on mixed-methods, ethnographic research in government health facilities conducted in Rukwa, Tanzania over 23 months between 2012 and 2015, this paper explores the social implications of budget shortfalls in the healthcare system at the level of a regional hospital. Budget crises resulted from the late disbursal of funds and the failure of outside donors to meet aid commitments needed to subsidize healthcare at the national level. Healthcare administrators recounted specific donors who pulled out of commitments as a direct result of foreign government austerity measures enacted after the global financial crisis of 2008...
February 7, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28197297/reconstruction-of-an-anterior-cervical-necrotizing-fasciitis-defect-using-a-biodegradable-polyurethane-dermal-substitute
#14
Marcus Jd Wagstaff, Yugesh Caplash, John E Greenwood
Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis...
2017: Eplasty
https://www.readbyqxmd.com/read/28155775/-oral-health-and-the-nurse-8217-s-role-in-qu-233-bec
#15
Hermina Harnagea
<ce:para>Various international health care organizations strongly recommend the implication of non-dental health care professionals in oral health. Consequently, nurses are currently often required to question their ability to manage patients’ oral health-related problems, as well as the very meaning of their management of patients in such situations. The purpose of this paper is to draw attention to the role of the nurse in the management of oral health. Professional associations and academic institutions involved in the development of nursing professional skills, and health policymakers involved in decisions concerning the geographical distribution of nursing personnel and adoption of laws in Quebec, act in a disconnected manner, independently from dental professionals and without taking into account the actual oral health care needs of the various categories of beneficiaries...
December 19, 2016: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
https://www.readbyqxmd.com/read/28059581/hot-and-cold-drugs-national-park-service-medication-stability-at-the-extremes-of-temperature
#16
Patil Armenian, Danielle Campagne, Geoff Stroh, Crystal Ives Tallman, William Z D Zeng, Thomas Lin, Roy R Gerona
STUDY OBJECTIVE: National Park Service (NPS) Parkmedics provide medical care in austere environments. The objective of this study was to evaluate the stability of specific medications used by Parkmedics at extremes of temperatures likely to be faced in the field. METHODS: This is a bench research study conducted in the laboratory setting over a 4-week period. Parenteral medications were separated into 4 temperature exposure groups: A) 45°C (hot); B) -20°C (cold); C) hot then cold temperatures alternating weekly; and D) cold then hot temperatures alternating weekly...
January 6, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28051988/ultraportable-oxygen-concentrator-use-in-u-s-army-special-operations-forward-area-surgery-a-proof-of-concept-in-multiple-environments
#17
Michael Rybak, Lynn C Huffman, Richard Nahouraii, John Loden, Marcos Gonzalez, Ramey Wilson, Paul D Danielson
INTRODUCTION: A limitation to surgical care in an austere environment is the supply of oxygen to support mechanical ventilation and general anesthesia. Portable oxygen concentrators (OCs) offer an alternative to traditional compressed oxygen tanks. OBJECTIVES: We set out to demonstrate that a low-pressure OC system could supply the mechanical ventilation needs in an austere operating environment. METHODS: An ultraportable OC (SAROS Model 3000, SeQual Technologies, Ball Ground, Georgia) was paired with an Impact 754 ventilator (Impact Instrumentation, West Caldwell, New Jersey) to evaluate the delivered fraction of inspired oxygen (FiO2) to a test lung across a range of minute ventilations and at altitudes of 1,200 and 6,500 feet above sea level...
January 2017: Military Medicine
https://www.readbyqxmd.com/read/28034410/a-review-of-electronic-medical-record-keeping-on-mobile-medical-service-trips-in-austere-settings
#18
REVIEW
Christopher Dainton, Charlene H Chu
INTRODUCTION: Electronic medical records (EMRs) may address the need for decision and language support for Western clinicians on mobile medical service trips (MSTs) in low resource settings abroad, while providing improved access to records and data management. However, there has yet to be a review of this emerging technology used by MSTs in low-resource settings. The aim of this study is to describe EMR systems designed specifically for use by mobile MSTs in remote settings, and accordingly, determine new opportunities for this technology to improve quality of healthcare provided by MSTs...
February 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27941590/traumatic-hemothorax-blood-contains-elevated-levels-of-microparticles-that-are-prothrombotic-but-inhibit-platelet-aggregation
#19
Thomas A Mitchell, Maryanne C Herzig, Chriselda G Fedyk, Marc A Salhanick, Aaron T Henderson, Bijaya K Parida, Nicolas J Prat, Daniel L Dent, Martin G Schwacha, Andrew P Cap
OBJECTIVES: Autotransfusion of shed blood from traumatic hemothorax is an attractive option for resuscitation of trauma patients in austere environments. However, previous analyses revealed that shed hemothorax (HX) blood is defibrinated, thrombocytopenic, and contains elevated levels of D-dimer. Mixing studies with normal pooled plasma demonstrated hypercoagulability, evoking concern for potentiation of acute traumatic coagulopathy. We hypothesized that induction of coagulopathic changes by shed HX blood may be due to increases in cellular microparticles (MP) and that these may also affect recipient platelet function...
December 9, 2016: Shock
https://www.readbyqxmd.com/read/27893618/early-resuscitation-with-lyophilized-plasma-provides-equal-neuroprotection-compared-with-fresh-frozen-plasma-in-a-large-animal-survival-model-of-traumatic-brain-injury-and-hemorrhagic-shock
#20
Ihab Halaweish, Ted Bambakidis, Vahagn C Nikolian, Patrick Georgoff, Peter Bruhn, Patryk Piascik, Lisa Buckley, Ashok Srinivasan, Baoling Liu, Yongqing Li, Hasan B Alam
BACKGROUND: Combined traumatic brain injury (TBI) and hemorrhagic shock (HS) is highly lethal. In previous models of combined TBI + HS, we showed that early resuscitation with fresh frozen plasma (FFP) improves neurologic outcomes. Delivering FFP, however, in austere environments is difficult. Lyophilized plasma (LP) is a logistically superior alternative to FFP, but data are limited regarding its efficacy for treatment of TBI. We conducted this study to determine the safety and long-term outcomes of early treatment with LP in a large animal model of TBI + HS...
December 2016: Journal of Trauma and Acute Care Surgery
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